Picture This: Exploring the Lived Experience of High-Functioning Stroke Survivors Using Photovoice.

An increasing number of high-functioning stroke survivors are present with minimal functional impairments and are often discharged with reduced access to community reintegration. Our objectives were to explore the lived experience of high-functioning stroke survivors and to identify gaps in community and rehabilitation services. Photovoice was used with five high-functioning stroke survivors to photo-document their experiences. A modified inductive thematic analysis was used, and meanings behind the photographs were elicited through four focus group sessions followed by photography exhibitions. Five themes emerged: lack of understanding and consideration for persons with disability, emotional and behavioral impacts after stroke, self-reliance and dependence on others, importance of appropriate and accessible services, and financial determinants of quality of life. By including service users' voices; investing in adapted, community-based programs; and providing educational programs for creating attitudinal change among service providers, the polarization between who can and cannot access services will be reduced.

Test-retest reliability and minimal detectable change of the SmartWheel clinical protocol.

OBJECTIVES: (1) To quantify the intra- and intersession reliability and minimal detectable change (MDC) of the SmartWheel clinical protocol (SCP) and (2) to compare the reliability of the SCP between experienced and naïve wheelchair users. DESIGN: Test-retest study. SETTING: Biomechanics laboratory. PARTICIPANTS: Manual wheelchair users (WCUs) (n=10) with 1 to 32 years of wheeling experience and able-bodied (AB) naïve users (n=15). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Wheelchair propulsion parameters including average peak force, push frequency, push length, and velocity were measured according to the SCP but with 5 trials per session, for 2 sessions. WCUs and AB users were analyzed separately. Intraclass correlation coefficients ([ICC](2,1) and ICC(2,5)) were calculated to assess intrasession reliability. ICC(2,1) and MDC (with 95% confidence) were calculated for each SCP parameter using a single trial from each session and with the mean of 5 repeated measures to evaluate intersession reliability. RESULTS: Intra- and intersession reliability for WCU parameters ranged from high to very high correlation (ICC range, .70-.99). For AB parameters, intrasession ICC(2,1) ranged from moderate to very high (ICC range, .50-.92), while intersession ICC(2,1) indicated low to very high correlation (ICC range, .25-.90). Estimates of standard error of measurement and MDC were provided for each parameter. For both WCUs and AB users, using the means from 5 trials increased intra- and intersession ICC and decreased MDC values. All MDC values were lower for WCUs compared with AB users. CONCLUSIONS: The SCP is a reliable method for assessing propulsion parameters in WCUs, even if just 1 trial is taken per session. AB users showed lower intra- and intersession reliability compared with WCUs. Therefore, for AB users or individuals with minimal wheeling experience, averaging multiple trials is recommended for the SCP.

Mechanical efficiency of two commercial lever-propulsion mechanisms for manual wheelchair locomotion.

The purpose of this study was to (1) evaluate the mechanical efficiency (ME) of two commercially available lever-propulsion mechanisms for wheelchairs and (2) compare the ME of lever propulsion with hand rim propulsion within the same wheelchair. Of the two mechanisms, one contained a torsion spring while the other used a roller clutch design. We hypothesized that the torsion spring mechanism would increase the ME of propulsion due to a passive recovery stroke enabled by the mechanism. Ten nondisabled male participants with no prior manual wheeling experience performed submaximal exercise tests using both lever-propulsion mechanisms and hand rim propulsion on two different wheelchairs. Cardiopulmonary parameters including oxygen uptake (VO2), heart rate (HR), and energy expenditure (En) were determined. Total external power (Pext) was measured using a drag test protocol. ME was determined by the ratio of Pext to En. Results indicated no significant effect of lever-propulsion mechanism for all physiological measures tested. This suggests that the torsion spring did not result in a physiological benefit compared with the roller clutch mechanism. However, both lever-propulsion mechanisms showed decreased VO2 and HR and increased ME (as a function of slope) compared with hand rim propulsion (p < 0.001). This indicates that both lever-propulsion mechanisms tested are more mechanically efficient than conventional hand rim propulsion, especially when slopes are encountered.